Background: Bladder cancer is a disease of the elderly associated with high morbidity in those undergoing radical cystectomy (RC). The Optimized Surgical Journey (OSJ) uses enhanced recovery after surgery (ERAS) principles for RC patients to improve postoperative pain and shorten hospital stay. There have been few patient reported outcomes studied in OSJ and ERAS patients. The MD Anderson Symptom Inventory (MDASI) is patient reported outcome measures used for clinical and research purposes related to cancer and its treatment. Our objective was to determine if patient reported outcomes using MDASIs are different in patients following the OSJ compared to a traditional care pathway. Methods: From July 2013 to November 2015, MDASIs were collected from 160 RC patients preoperatively and on postoperative days (POD) 1 through 3. The MDASI consists of 19 core symptom burden related questions and 6 questions analyzing how symptoms have interfered with the patient’s life. Using a 0-10 scale, patient’s rate their symptoms. T-test, Man-Whitney where appropriate and logistic regression were used for multivariable cross sectional analysis. Results: The most bothersome symptoms were abdominal discomfort, disturbed sleep, dry mouth, fatigue, and drowsiness. Nausea, vomiting, bowel pattern, bowel control and appetite were all found to be insignificant. Abdominal discomfort was reported significantly less in OSJ patients on PODs 1 and 2 (p = 0.032 and 0.001, respectively). In multivariable analysis OSJ status was predictive of less abdominal pain (p < 0.001). Dry mouth was also significantly burdensome on PODs 1 and 2 (p = 0.022 and < 0.001, respectively) in non-OSJ patients. Less dry mouth was also predicted by OSJ status in multivariable analysis (p = 0.014). Disturbed sleep, fatigue, and drowsiness were significantly less in patients on the OSJ POD 2. Mood was better in OSJ patients PODs 2 and 3 (p = 0.016). Conclusions: The OSJ can significantly reduce the burden of symptoms in RC patients immediately postoperatively. MDASIs maybe a helpful tool to measure symptom burden. This information can be used in the future to create additional interventions for improvement in RC patient recovery experiences.